Classification and Treatment of Supramalleolar Deformities

Knupp, Markus; Stufkens, Sjoerd A. S.; Bolliger, Lilianna; Barg, Alexej; Hintermann, Beat

doi:10.3113/fai.2011.1023

Cited by 167 publications

(144 citation statements)

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“…Recently, corrective osteotomies to realign the hindfoot in patients suffering from asymmetric ankle arthritis have been introduced [13][14][15][16]. The goal of these procedures is to redirect forces transmitted across the hindfoot and to shift the loading axis into the area of healthy cartilage.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of MRI measurements to assess hindfoot malalignment. An assessment of four measurement techniques

et al. 2013

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OBJECTIVE: To investigate the ability of coronal non-weight-bearing MR images to discriminate between normal and abnormal hindfoot alignment. METHODS: Three different measurement techniques (calcaneal axis, medial/lateral calcaneal contour) based on weight-bearing hindfoot alignment radiographs were applied in 49 patients (mean, 48 years; range 21-76 years). Three groups of subjects were enrolled: (1) normal hindfoot alignment (0°-10°valgus); (2) abnormal valgus (>10°); (3) any degree of varus hindfoot alignment. Hindfoot alignment was then measured on coronal MR images using four different measurement techniques (calcaneal axis, medial/lateral calcaneal contour, sustentaculum tangent). ROC analysis was performed to find the MR measurement with the greatest sensitivity and specificity for discrimination between normal and abnormal hindfoot alignment. RESULTS: The most accurate measurement on MR images to detect abnormal hindfoot valgus was the one using the medial calcaneal contour, reaching a sensitivity/specificity of 86 %/75 % using a cutoff value of >11°valgus. The most accurate measurement on MR images to detect abnormal hindfoot varus was the sustentaculum tangent, reaching a sensitivity/specificity of 91 %/71 % using a cutoff value of <12°valgus. CONCLU-SION: It is possible to suspect abnormal hindfoot alignment on coronal non-weight-bearing MR images. KEY POINTS : • Abnormal hindfoot alignment can be identified on coronal non-weight-bearing MR images.• The sustentaculum tangent was the best predictor of an abnormally varus hindfoot.• The medial calcaneal contour was the best predictor of a valgus hindfoot. AbstractObjective To investigate the ability of coronal non-weightbearing MR images to discriminate between normal and abnormal hindfoot alignment. Methods Three different measurement techniques (calcaneal axis, medial/lateral calcaneal contour) based on weightbearing hindfoot alignment radiographs were applied in 49 patients (mean, 48 years; range 21-76 years). Three groups of subjects were enrolled: (1) normal hindfoot alignment (0°-10°v algus); (2) abnormal valgus (>10°); (3) any degree of varus hindfoot alignment. Hindfoot alignment was then measured on coronal MR images using four different measurement techniques (calcaneal axis, medial/lateral calcaneal contour, sustentaculum tangent). ROC analysis was performed to find the MR measurement with the greatest sensitivity and specificity for discrimination between normal and abnormal hindfoot alignment.Results The most accurate measurement on MR images to detect abnormal hindfoot valgus was the one using the medial calcaneal contour, reaching a sensitivity/specificity of 86 %/75 % using a cutoff value of >11°valgus.The most accurate measurement on MR images to detect abnormal hindfoot varus was the sustentaculum tangent, reaching a sensitivity/specificity of 91 %/71 % using a cutoff value of <12°valgus. Conclusion It is possible to suspect abnormal hindfoot alignment on coronal non-weight-bearing MR images.

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Section: Discussionmentioning

confidence: 99%

Diagnostic performance of MRI measurements to assess hindfoot malalignment. An assessment of four measurement techniques

et al. 2013

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“…We based the decision to perform the fibular osteotomy on the pre- and intraoperative evaluation. When the TC angle is decreased more than 5° compared with the contralateral side, which indicates a longer fibula or varus change, a fibular osteotomy may facilitate the reduction of the tibial plafond and talus [19]. Stufkens et al [6] reported that creating a supramalleolar valgus deformity would not cause a shift in contact towards the lateral side of the tibiotalar joint, and the restricting role of the fibula was revealed when an osteotomy was performed.…”

Section: Discussionmentioning

confidence: 99%

“…The role of TT in SMOT is highly controversial. Some authors have reported a significant decrease of the TT [4, 7, 8, 11, 17]; however, others have not [3, 12, 15, 19]. Tanaka et al [12] reported that in all patients with a preoperative TT greater than 10°, the joint space did not return to normal.…”

Section: Discussionmentioning

confidence: 99%

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The role of fibular for supramalleolar osteotomy in treatment of varus ankle arthritis: a biomechanical and clinical study

Zhao

Liang

et al. 2016

J Orthop Surg Res

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BackgroundSupramalleolar osteotomy (SMOT) is a well-accepted treatment method for mid-stage varus ankle osteoarthritis (OA). However, few studies have examined the role of fibular osteotomy in SMOT. The objective of the current study was to compare the biomechanical and clinical outcomes of SMOT with and without fibular osteotomy.MethodsEight cadaveric lower legs with 10° varus/valgus SMOT models were tested using a Tekscan ankle sensor. Tibiotalar joint contact with and without fibular osteotomy conditions were compared. Forty-one varus ankle OA patients treated with SMOT were included; 22 underwent fibular osteotomy, and 19 did not. The Maryland foot score and radiological angles were used for clinical evaluation.ResultsThe mean contact area and pressure did not differ significantly between normal and varus/valgus conditions with the fibula preserved. After fibular osteotomy, the mean contact area decreased and the mean contact pressure increased significantly in varus and valgus conditions (P < 0.01). The loading center moved to the opposite direction with and without fibular osteotomy in varus/valgus conditions. After a mean follow-up of 36.6 months (range 17–61), there was no significant difference in the Maryland scores of the two groups. However, in the fibular osteotomy group, the talar tilt angle decreased (P < 0.05), and the tibiocrural angle improved significantly (P < 0.01).ConclusionsFibular osteotomy facilitates the translation of tibiotalar contact pressure and is helpful for varus ankle realignment in patients with large talar tilts and small tibiocrural angles.

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“…25 The medial and lateral approach is based on the amount of correction desired. 26 The medial opening wedge osteotomy has the advantages of using a simple approach, ease of bone cuts, and no resultant limb length discrepancy. The lateral closing wedge osteotomy allows for ease of fixation, no graft requirement, reliable and rapid healing, and no possibility of medial joint load increase.…”

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confidence: 99%